Basic Information
| Provider Information | |||||||||
| NPI: | 1114213675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERSHING | ||||||||
| FirstName: | REBEKAH | ||||||||
| MiddleName: | LEA | ||||||||
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| Credential: | MD- PHYCHOLOGY | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HODGES | ||||||||
| OtherFirstName: | REBEKAH | ||||||||
| OtherMiddleName: | LEA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2357 SEQUOIA DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605066222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308596800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2500 W FABYAN PKWY | ||||||||
| Address2: | |||||||||
| City: | BATAVIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605101572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308792110 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2011 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6784 | OH | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.